MEDICARE: VISHNU K RUMALLA, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1134365802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISHNU K RUMALLA, M.D.

Provider Business Mailing Address
First Line	:	800 EIGHTH AVE
Second Line	:	SUITE #240
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2619
Country	:	US
Telephone Number	:	817-334-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 EIGHTH AVE
Second Line	:	SUITE #240
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2619
Country	:	US
Telephone Number	:	817-334-0030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VISHNU RUMALLA
Credential	:
Telephone Number	:	817-334-0030

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	12/30/2008

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